Free again

For more than 50 years, a procedure pioneered at the U of M has reopened doors for people who have difficult-to-control type 1 diabetes

For Joanie Videen, having type 1 diabetes meant never getting a good night’s sleep.

As her disease worsened, doctors advised Videen, who developed diabetes at age 35, to check her blood glucose level every three hours—even in the middle of the night. She followed that routine for nine years.

“No matter where I was, I had to check my number,” she says. “Every night, I never got more than three hours of sleep in a row. It was a real challenge at work. I had difficulty concentrating.”

Videen was “hypoglycemia unaware,” meaning her body didn’t give her warning signs when her blood glucose levels were dropping dangerously low. Whereas most people typically feel shaky, sweaty, and weak when their blood glucose levels drop, people who are “unaware” don’t experience these sensations, which puts them in danger of suddenly passing out or having a seizure. This is a particularly dangerous prospect if the person is driving or alone.

Videen needed a solution. Because of her hypoglycemia unawareness, she was eligible for a pancreas transplant. The pancreas houses the body’s insulin-producing islet cells, which normally regulate a person’s blood sugar. But in people who have type 1 diabetes, the immune system mistakenly attacks and destroys those cells, and the pancreas no longer does its job.

About six months after she was added to the transplant list, Videen underwent the life-changing surgery.

In good hands

At the University of Minnesota Medical Center, Videen was tapping into a long and rich history of transplant innovation. This year the U is celebrating the 50th anniversary of the world’s first pancreas transplant, which was performed in December 1966 by surgeons Richard C. Lillehei, M.D., and William D. Kelly, M.D., proving that a person with diabetes can live without insulin injections.

Since then, more than 50,000 pancreas transplants have been performed worldwide. University of Minnesota teams, led for decades by David E. R. Sutherland, M.D., Ph.D., have completed upward of 2,300 of them—more than any other transplant center in the world.

Thanks to advances in modern medicine, pancreas transplants today typically have success rates near 90 percent, according to University of Minnesota Health transplant surgeon Raja Kandaswamy, M.D., who is the director of pancreas transplantation and a professor in the Medical School’s Department of Surgery. Advanced surgical techniques, improved immunosuppressive medications that decrease the chances of rejection, and better antibiotics have all contributed to the improved outcomes.

That’s good news for people with type 1 diabetes who are eligible for pancreas transplants. In 1992, one out of every six diabetics would not live to see their 40th birthday.

Pancreas transplants have quickly become a standard option for people who have type 1 diabetes and kidney failure (diabetes often causes kidney damage, too). As transplant numbers continue to grow, researchers and surgeons are working to develop less invasive alternatives for those who require this treatment.

One of those alternatives is allo-islet transplantation, a procedure that is currently in late-stage clinical trials at the University of Minnesota under the direction of the Schulze Diabetes Institute’s Bernhard Hering, M.D., holder of the Eunice L. Dwan Chair in Diabetes Research. During the procedure, doctors infuse islet cells into a patient’s liver. Once placed into the liver, the cells begin creating insulin and sending it directly into the bloodstream, essentially acting as a functioning pancreas. Often, the procedure—developed over the years with the support of philanthropy—allows patients to be insulin-free for long periods of time.

BRADY WILLETTE

“While minimally invasive, it is not currently as effective as a standard pancreas transplant. However, we expect the results to improve,” Kandaswamy says. “In the future, islet transplantation may become the new standard of care, with a pancreas transplant serving as an alternative option.”

A better life

Thanks to innovations like these, Videen and thousands of others who once had difficult-to-control diabetes are rediscovering the freedoms of not being tied to the clock to constantly monitor their blood glucose levels. In fact, Videen only checks her blood glucose once daily now—compared with 11 times daily before her transplant. She has been insulin-free since the surgery.

“Shortly after the transplant, my husband and I went scuba diving. I love being under water, but they won’t let you rent equipment when you’re diabetic,” Videen says. “I didn’t think I would ever do that again.”

She also now enjoys waterskiing, boating, traveling alone, driving for as long as she wants to, and sleeping all night.

Says Videen: “It’s amazing how alert you can be during the day with a good night’s sleep.”

To learn how you can support this work, contact Jean Gorell at 612-625-0497 or jgorell@umn.edu.